August 30, 2011



In a hospital setting may we bill some patients a facility fee, while writing off for others, such as University Students?




Noteworthy at the start of an analysis to this question is that the asker has identified a distinct patient population - university students - who presumably have health insurance.

Typically this question involves the billing or failure to bill co-pays, as opposed to entire services or elements of a service, as seen above. Here, the question as to whether it is appropriate to bill for the actual facility fee for some patients, but not others would be governed directly by contract. The contract(s) I am alluding to are those entered into with third party payors. Presumably University Students have insurance, and/or presumably the Hospital is a participating provider. If either of those presumptions are correct, than at least 1 party in this arrangement (most likely both) are bound by contract. Depending upon the conditions in the contract(s) will determine the billing requirements.

Another consideration is by offering reduced amounts for services rendered (waiving a facility fee), the hospital is arguably inducing University Students to come to their facility. This may potentially be seen as a prohibited arrangement and open the hospital up to enormous liability.

L - For a more detailed analysis of this arrangement I would definitely need additional information and you should obtain a formal a regulatory compliance review, which our firm would be happy to provide.


Copyright © 2011 by Kirschenbaum & Kirschenbaum, P.C.

All Rights Reserved. This email is provided for news and information purposes only and does not constitute legal advice or an invitation to an attorney-client relationship. While every effort has been made to ensure the accuracy of the information contained herein, Kirschenbaum & Kirschenbaum PC does not guarantee such accuracy and cannot be held liable for any errors in, any reliance upon this, or losses caused by the information. Under New York’s Code of Professional Responsibility, this material may constitute attorney advertising. Prior results do not guarantee a similar outcome.